tbuckley/cabot-search huggingface dataset:
BH02 Online psychological support for patients with alopecia areata: an evaluation of available online psychological support material based on the National Centre for Complementary and Integrated Health guidelines
Authors: Rebecca Lumley, Leila Asfour, Kerry Montgomery
Journal: British Journal of Dermatology (2023)

Abstract Alopecia areata is an autoimmune disorder causing nonscarring hair loss that is associated with significant psychological comorbidity (Macbeth AE, Holmes S, Harries M et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol 2022; 187:73–81). In addition to seeking psychological support from medical professionals, patients will often turn to online resources. In this study, we evaluated the range and quality of the online psychological support material available for patients with alopecia areata. A Google search was undertaken using private browsing on 5 June 2022, with several search terms: ‘alopecia areata online support group UK’, ‘alopecia support’ and ‘alopecia areata psychology’. The National Centre for Complementary and Integrated Health (NCCIH) guidelines for the evaluation of online resources were used. These guidelines assess information source and accuracy, funding, peer review status, linking policies and contemporaneity. Our search generated a total of 154 000 results. Advertisements, scientific articles, educational resources and duplicates were excluded, with nine resources included in the final analysis. Of the nine resources reviewed, three were specific for patients with alopecia areata, with the remaining resources focused on other types of hair loss. Six were authored or reviewed by dermatologists and seven had a documented peer review process of their content. One resource had no clear authorship and three had no clear peer review process. Nine of the resources were charity funded and one was a National Health Service resource. Four had been updated in the last 3 years and a further two within 5 years. All resources had clearly documented security and linking policies. All resources acknowledged the psychological impact of hair loss and eight had links to support groups or discussion forums. Only five had psychological support and advice on their website, with others only referring to the psychological burden and then signposting patients on to other sources for support. Only three of the resources referred to therapies such as cognitive behavioural therapy. The prevalence of mental health comorbidity in alopecia areata is high compared to the general population (Macbeth et al.). Our preliminary study has shown that the online psychological support available is lacking. With patients increasingly turning to the Internet for support and health information, there is an opportunity and need for development in this area.
H04 The sign of Leser–Trélat: an eponymous misnomer?
Authors: Maryam Salimi, Huda Al-Kutubi, Kashini Andrew, Pooja Patel, Stephen Orpin, Adrian Heagerty
Journal: British Journal of Dermatology (2023)

Abstract The sign of Leser–Trélat is a paraneoplastic phenomenon consisting of a sudden eruption of seborrhoeic keratoses. It is credited to two surgeons, Edmund Leser (1853–1918) and Ulysse Trélat (1827–1890), who described cutaneous lesions associated with internal malignancies. Edmund Leser, the author of the Textbook of Special Surgery in 50 Lectures, initially studied law in Bonn before qualifying in medicine in Leipzig in 1880. He became Richard von Volkmann’s assistant at Martin Luther University. He was awarded his chair of surgery in 1894, 10 years after becoming a surgeon, and he practised in Goethe University, Frankfurt. Ulysse Trélat was born in Paris in 1827. His father was a republican political activist, Minister of Public Works and known as the founder of public hygiene in France. Ulysse Trélat was employed as an assistant anatomist in surgery at the ‘École Pratique’ 1 year before graduating high school in 1844. He finished his medical studies in 1854 and became a surgeon in 1857. In 1858, he was running the anatomy course in ‘École Pratique’. He replaced Paul Broca, well known for his research on Broca’s area in the frontal lobe, at Hospital Necker in 1880. In 1884, he was awarded a chair of surgery at ‘Hospital de la Charite’, replacing Leon Athanase Gosselin. Notable among his works is the description of the ‘Baizeau and Trélat method’ of surgical repair of cleft palate, and his book Clinique Chirurgicale. Leser and Trélat independently published papers describing skin lesions associated with mammary carcinoma and visceral malignancies. However, their description of cutaneous lesions was more in keeping with the appearance of senile angiomata or Campbell de Morgan spots. Therefore, the credit should go to Eugen Von Hollander (1867–1932), another German surgeon who accurately described the lesions in a paper published in 1900 titled ‘Contributions to the early diagnosis of intestinal carcinomas’. He observed skin changes associated with internal malignancies consisting of an eruption of flat, shiny, pigmented, glandular, epithelial growths similar to seborrhoeic warts or verrucae seniles in young patients with cancer. He hypothesized that there might be a link between abnormal epithelial proliferation in internal organs and skin keratinocyte proliferation. He is remembered for performing the first facelift, on a Polish aristocrat in 1912. The sign of Leser–Trélat is so deeply embedded in medical literature and the minds of modern practitioners that it is unlikely to ever be erased. However, the contribution of Eugen Von Hollander should not be forgotten.
P59 Results of sentinel lymph node biopsies in thin melanomas (Breslow thickness 0.8–1.0 mm) and correlation with histopathological features
Authors: Bernard Anton Kenny, Alana Durack
Journal: British Journal of Dermatology (2023)

Abstract In July 2022, the National Institute for Health and Care Excellence (NICE) melanoma guidelines were updated to include recommendation for a sentinel lymph node (SLN) biopsy for those with a Breslow thickness of 0.8–1 mm and at least one of the following: ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2 mm². SLN biopsy is a staging procedure and therefore has an impact on prognosis. However, SLN biopsy is an invasive procedure with associated morbidity. A 5-year retrospective review of melanoma data in the south east of Ireland was undertaken to establish the correlation between positive sentinel lymph node biopsies in 0.8–1.0-mm-thick melanomas and the risk factors outlined above. Melanoma outcomes, histopathology reports and outpatient clinic letters were assessed and data were extracted from 1 January 2018 to 31 December 2022 inclusive. A total of 52 patients were identified with a melanoma of Breslow thickness of 0.8–1 mm from the predetermined timeframe. Eight per cent (n = 4) of lesions were ulcerated. Thirteen per cent (n = 7) had a mitotic index of ≥ 2 mm². One lesion was both ulcerated and had a mitotic index of ≥ 2 mm². No lesions demonstrated lymphovascular invasion. Nineteen (36%) patients underwent SLN biopsy. All patients who underwent SLN biopsy were negative. One patient with an ulcerated melanoma did not undergo SLN biopsy and five with a mitotic index of ≥ 2 did not undergo SLN biopsy. There was no evidence of disease recurrence within the follow-up period (2 months–5 years). This population showed a 0% positivity rate on SLN biopsy. No correlation with mitotic index or ulceration and SLN biopsy was identified. No patients have developed local recurrence or metastatic disease within the follow-up period. This study supports the updated NICE guidance recommending SLN biopsies for thicker melanomas (i.e. Breslow thickness &amp;gt; 1.0 mm) and SLN biopsy in thinner melanomas (Breslow thickness 0.8–1 mm) only if concerning features are present on histology (i.e. ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2).
P67 Overall lifetime risk for alopecia areata is 2.1% and is higher in women, non-White ethnic groups and the most deprived: a UK population-based cohort study
Authors: Andrew R Thompson, Christos Tziotzios, John Nesnas, Rowena Randall, Maciej Czachorowski, Andrew Messenger
Journal: British Journal of Dermatology (2023)

Abstract Alopecia areata (AA) is an immune-mediated nonscarring alopecia often associated with substantial morbidity. However, there are limited population-based data on potential disparities in the burden of AA, including across different ethnicities and sociodemographic classifications. We aimed to provide the first large-scale, population-based evaluation of lifetime risk of AA across sociodemographic subgroups. This study used routinely collected data from a large UK population-based database: the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). All children and adults registered with general practices contributing to the RCGP RSC network in the period 2009–2018 without a prior diagnosis of AA were included. People were considered to develop AA if they had an AA diagnosis and, in the subsequent 365 days, no code for an alternative diagnosis (e.g. traction alopecia and scarring alopecia). The cumulative lifetime risk of AA was estimated at age 80 years using survival models, with age as the timescale and accounting for the competing risk of death. Lifetime risk was calculated for the whole population and by sociodemographic subgroups comprising sex, major UK ethnicity groups and socioeconomic deprivation. In a total population of 4 052 231, 6961 developed new-onset AA. The lifetime risk in the overall population was 2.11% [95% confidence interval (CI) 2.06–2.16]. There was substantial difference in lifetime risk of AA by ethnicity; lifetime risk was 1.74% (95% CI 1.68–1.80) in the White subgroup, 5.87% (95% CI 5.51–6.24) in Asian, 3.03% (95% CI 2.63–3.42) in Black, 4.44% (95% CI 3.50–5.37) in mixed and 4.47% (95% CI 3.63–5.31) in other ethnic groups. Females had a higher lifetime risk of AA than males: 2.35% (95% CI 2.28–2.43) vs. 1.88% (95% CI 1.81–1.94). Lifetime risk was greater with increasing socioeconomic deprivation: least-deprived 1.68% (95% CI 1.59–1.78) vs. most-deprived quintile 2.92% (95% CI 2.77–3.07). Our findings demonstrate that AA affects nearly 1 in 50 people over a lifetime. Lifetime risk is substantially greater in people of non-White ethnicity and is highest in those of Asian ethnicity (one in 17 people). The lifetime risk is also higher in females and those with the greatest socioeconomic deprivation. Clinicians should be aware of the disproportionate distribution of AA across the population and support the provision of healthcare resource to groups with the highest burden. Funding sources: this research was sponsored by Pfizer. Project management, medical writing and statistical support were provided by Momentum Data, UK, and were funded by Pfizer.
H09 Is cannabis use in dermatology topical? Reviving the historical highs
Authors: Emily Moon, Simon Unter, Bruce Gee
Journal: British Journal of Dermatology (2023)

Abstract Cannabis refers to product derived from a plant species known as Cannabis sativa. The plant contains cannabinoids, two of the most prominent being tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary psychoactive component in cannabis, while CBD, discovered by chemist Roger Adams in 1942, is nonpsychoactive. Cannabis with high THC levels is referred to as marijuana. With global policy changes and government approvals, CBD has recently garnered significant interest due to increased awareness of its therapeutic potential. This surge in demand has fuelled the multi-billion-dollar global CBD market with projections of sustained growth in the future. The use of cannabis for medicinal purposes has a rich history, dating back to ancient civilizations. From traditional Chinese medicine using cannabis preparations for rashes to ancient Egyptians using it for wounds to Arab traditional medicine using it to treat lichen planus, the therapeutic benefits of cannabis have been widely recognized throughout history. Sir William O’Shaughnessy, an Irish physician, discovered the therapeutic properties of cannabis in India in the 19th century and led to its widespread use in Europe and North America. However, in the early 20th century, cannabis was banned in many countries as part of a movement to control the use of addictive substances. The discovery of the endocannabinoid system in the late 20th century marked a turning point in the understanding of how cannabinoids interact with our bodies. This intricate network, made up of endocannabinoids, cannabinoid receptors and enzymes, regulates pain perception, metabolism, circadian rhythm, immune system, and more. Preclinical evidence supports the therapeutic potential of topical CBD for dermatological inflammatory diseases such as acne and eczema, as well as skin cancer (Lowe H, Toyang N, Steele B et al. The endocannabinoid system: a potential target for the treatment of various diseases. Int J Mol Sci 2021; 22:9472). The accumulation of evidence supporting its therapeutic potential has led to a change in societal and cultural perspectives toward cannabis, resulting in the UK government’s approval of limited medicinal use in 2018, as well as the opening of the nation’s first legal cannabis farm in 2021. In 2018, Epidyolex® (cannabidiol) became the first US Food and Drug Administration-approved medical-grade CBD for treating rare forms of epilepsy. Cannabis’ potential therapeutic properties offer a promising outlook for cannabis-based medicine in dermatology. While CBD’s lipophilic nature and its instability in solution pose challenges for its transdermal delivery, ongoing research and study may offer solutions. It is imperative that dermatologists stay informed about CBD advancements as its growing availability and potential indications are likely to drive its popularity.
PA23 Primary cutaneous Ewing sarcoma in a 14-year-old boy
Authors: Gavin O’Sullivan, Hamisha Salih, Anne Davidson, Catherine Wynne, Mark Taylor, Susannah George
Journal: British Journal of Dermatology (2023)

Abstract A 14-year-old boy presented with a 7-month history of a nodule on the right shoulder. It was initially pink and pea-sized but developed black areas as it grew. It was nontender but bled occasionally. He was otherwise well and took no regular medications. He was originally from the Philippines, having moved to the UK 2 years previously. His mother had a history of breast cancer. This was suspected to be a pyogenic granuloma and treated with a shave biopsy. Histology showed largely patternless sheets of small, blue, round cells, with diffuse and strong membranous reactivity for CD99 on immunohistochemistry. Further molecular analysis revealed EWSR1–FLI1 fusion, confirming Ewing sarcoma. Staging imaging showed no metastatic disease. Following further surgery, he was treated as per the Euro-Ewing protocol with vincristine (V), doxorubicin (D), cyclophosphamide (C), ifosfamide (I), etoposide (E; nine induction cycles: alternate VDC/IE followed by five consolidation cycles IE/VC). Ewing sarcoma most commonly arises from bone and is the second most common bone malignancy in children with an incidence of 2.93 per million. Primary cutaneous Ewing sarcoma is extremely rare, with most of the literature consisting of case reports. A 2015 retrospective review of 56 cases of cutaneous/subcutaneous Ewing sarcoma from the UK and France found that most cases were on the extremities (48%) or trunk (39%). Primary cutaneous Ewing sarcoma tends to occur in late-adolescent or young-adult females, whereas bone disease affects younger patients with a male predominance. Current treatment is similar to treatment for Ewing arising from bone. However, primary cutaneous Ewing sarcoma has a more favourable prognosis, with a 5-year overall survival rate of 93.8%. In summary, cutaneous Ewing sarcoma is a very rare malignancy, particularly in the paediatric population. It is important to consider this in the differential diagnosis of erythematous nodular lesions in children, in order to minimize delays in treatment.
PD10 Objective evaluation of sunscreen in a patient with solar urticaria
Authors: Sareena Gajebasia, Alexandra McMullan, Laura Patullo, Ewan Eadie, Sally Ibbotson
Journal: British Journal of Dermatology (2023)

Abstract Sunscreens are an important part of photoprotection for patients with photodermatoses, such as solar urticaria (SU). Despite long ultraviolet (UV)A and visible wavelength photosensitivity in many patients with SU, sunscreens can still be beneficial (Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol 2003; 139:1149–54). However, unlike the objective assessment of photosensitivity by monochromator phototesting, formal evaluation of sunscreens’ effects is more challenging. We report a 32-year-old man with a 2-year history of immediate-onset photosensitivity, confirmed as SU on monochromator phototesting, with an action spectrum of UVB, UVA and visible light (305–460 nm). He had been using Nivea Sun SPF (sun protection factor) 50+ (Beiersdorf) and reported that this increased his tolerance of natural light from 10 to 60 min. Based on the sunscreen constituents, we were surprised to hear that it was so effective as there was no mineral constituent. Therefore, we evaluated his SU photosensitivity by UVA testing using a metal halide source [Honle UVASPOT 400 T; 24.09 mW cm−2; minimal urticaria dose (MUD) &amp;lt; 0.13 J cm−2] through his own sunscreen and, for comparison, Dundee Cream Beige (Tayside Pharmaceuticals) and LaRoche Posay Mineral One shade 01 (L’Oreal), both of which contain reflectant titanium dioxide. Three areas, measuring 15 × 10 cm, were marked out on his back and 0.15 mL of one sunscreen was applied to each. Each area was then irradiated through a Daavlin template using multiples (1×10) of the MUD and sites were observed for 30 min. As he was so severely photosensitive, none of the sunscreens affected the threshold MUD, but we noted delay in the induction of SU. Dundee Cream Beige offered minimal photoprotection, with urticaria occurring at 10 min vs. 5 min without sunscreen at 1 × MUD. LaRoche Posay SPF delayed the onset of SU to 30 min, and the reaction was less intense at 1 × MUD. However, the most marked effect was with his own Nivea SPF 50+. Urticaria induction was delayed to 30 min at 1 × MUD and was less intense, but it was also delayed to 15 min and less intense at a dose of 4 × MUD, confirming his impression that this sunscreen was of clinical benefit. We highlight this case to show how photodiagnostic testing can be employed to evaluate objectively the sunscreen effects in patients with photosensitivity. Conventionally, it is assumed that titanium dioxide-based products, such as the Dundee creams, are required in patients with longer UVA/visible light sensitivity, but with refinements in the development of new sunscreen products, this may not necessarily be the case.
DP13 A case of poikilodermatous plaque-like haemangioma: a newly described entity
Authors: Shahd Elamin, Claire Hennell, Olivia Dolan
Journal: British Journal of Dermatology (2023)

Abstract A 56-year-old man was referred with a 1.5 cm × 1.5 cm asymptomatic erythematous and scaly plaque on his right upper calf of 6 months’ duration. He had no similar lesions or prior skin issues. He had no significant comorbidities and was on no regular medications. There was no known family history of relevance. The initial clinical findings were felt to be in keeping with Bowen disease. He was treated once with cryotherapy, followed by two cycles of 5-fluorouracil cream, applied once daily over 4 weeks. Despite this, the plaque persisted and increased in size, measuring 3 cm × 2.5 cm. A 4-mm incisional biopsy was performed. Histopathology findings showed an acanthotic epidermis with compact hyperkeratosis, overlying a superficial dermal vascular lesion that consisted of a distinctive band-like proliferation of small endothelial cell-lined vessels. Background fibrosis and oedema were noted, as well as loss of elastic fibres within the lesional area, demonstrated by elastic van Gieson stain. Positive immunohistochemistry staining included CD31 and erythroblast transformation-specific-related gene stains, helping to confirm this lesion’s vascular origin, with a negative result for D2-40 (podoplanin), suggesting no lymphatic involvement. The histological appearances were thought to fit with a diagnosis of poikilodermatous plaque-like haemangioma (PPLH), a newly described entity of acquired vascular proliferation. Poikilodermatous plaque-like haemangioma, first described in 2019, usually presents as a solitary atrophic erythematous-to-violaceous plaque typically found in the lower limbs (Semkova K, Carr R, Grainger M et al. Poikilodermatous plaque-like hemangioma: case series of a newly defined entity. J Am Acad Dermatol 2019; 81:1257–70). Reassuringly, it has a benign course, but it can be persistent (Semkova et al.). Our patient was keen for treatment as the lesion was continuing to grow, causing him concern. However, there is sparse information available in the literature regarding effective treatments for PPLH. The case was discussed at the departmental clinicopathological meeting. The plaque was felt to be too superficial to merit any radiological investigation of the soft tissues. Surgical excision was discussed but given the size and location would most likely require a large skin graft. Sclerotherapy was considered but not felt to be appropriate in this setting. A trial of laser therapy was regarded as the best option given the superficial nature of this vascular lesion. He has since started a course of pulsed dye laser (PDL) at a wavelength of 585 nm, and we wait with interest to determine if it is effective. We therefore present this case to raise awareness of PPLH as a newly described entity and to consider it in the differential of a solitary atrophic erythematous plaque on a sun-protected site.